Key result
DOACs show comparable safety and efficacy to warfarin in severe obesity with NVAF or VTE.
Why the study?
Comparative safety and efficacy data for DOACs versus warfarin in patients with severe obesity remain limited.
Do DOACs provide comparable safety and efficacy to warfarin in adults with severe obesity (BMI ≥40 kg/m2) and NVAF or VTE?
Cohort
No
Do DOACs provide comparable safety and efficacy to warfarin in adults with severe obesity (BMI ≥40 kg/m2) and NVAF or VTE?
In a real-world setting, DOACs appear to have comparable safety and efficacy to warfarin in patients with severe obesity (BMI ≥40 kg/m2) treated for NVAF or VTE.
Should not yet change practice in severe obesity with AF or VTE; leaves open optimal anticoagulant pending dedicated RCTs.[[1]](https://pmc.ncbi.nlm.nih.gov/articles/PMC11095664/)[[2]](https://journals.sagepub.com/doi/10.
Background: ). Comparative safety and efficacy data for direct oral anticoagulants (DOACs) vs warfarin in this population remain limited. Objective: To compare the safety and efficacy of DOACs and warfarin in non-valvular atrial fibrillation (NVAF) and VTE in patients with severe obesity in a real-world setting. Methods: This single-center, retrospective matched cohort study included adults with severe obesity receiving a DOAC or warfarin for NVAF or VTE from January 1, 2019, to December 31, 2024. Patients were matched by age, sex, and indication. Primary outcomes were composite thrombotic events (recurrent VTE or ischemic stroke occurrence) and composite bleeding events (clinically relevant non-major and major bleed). Secondary outcomes were assessments of predictors for these events. Results: = 0.014, 95% CI = [1.28-8.74]) was a predictor for thrombosis. Conclusion: DOACs demonstrated comparable safety and efficacy to warfarin in patients with severe obesity with NVAF or VTE.
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Bautista et al. (2026) conducted a cohort in Non-valvular atrial fibrillation (NVAF) and venous thromboembolism (VTE) in severe obesity. Direct oral anticoagulants (DOACs) vs. Warfarin was evaluated on Composite thrombotic events (recurrent VTE or ischemic stroke) and composite bleeding events (clinically relevant non-major and major bleed). Direct oral anticoagulants demonstrated comparable safety and efficacy to warfarin for preventing thrombotic and bleeding events in patients with severe obesity and NVAF or VTE.
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